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Hunt 243 > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

What do recent studies show about maternal nutrition at conception

A

At time of conception it influences placental development and function.
Feral genomic imprinting and programming at conception directly tied to maternal peri conception nutrition and child’s long term health.

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2
Q

Preconception

A

The period before (at least two years) and between consecutive pregnancies

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3
Q

Proximal preconception

A

Period immediately preceding pregnancy (up to 2 years prior)

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4
Q

Distal preconception

A

Adolescence or in general a longer time before pregnancy

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5
Q

What is periconception

A

The preceding and immediately following human conception

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6
Q

Periconcepetion boundary

A

3 months before pregnancy and up to the first trimester

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7
Q

How long does it take for sperm to be made then released

A

10 weeks

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8
Q

How long does it take for eggs to be released

A

14weeks

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9
Q

What is the phases of periconception

A

Gametogenesis, fertilisation, implantation, embryogenesis, plancentation

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10
Q

What are the 5 ways to help make a healthy baby at periconception

A

Optimise health
Folic acid
Iodine
Healthy diet and lifestyle
Excess weight

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11
Q

How does obesity affect fertility

A

It tends to not make people inferior rather subfertile

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12
Q

How does obesity affect womens hormones

A

Higher levels of estrogen, androgens and leptin than non obese

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13
Q

How does obesity affect men’s hormones

A

Lower levels testosterone, increased estogen and leptin levels

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14
Q

How does obesity physiologically affect men’s reproduction

A

Reduced sperm production, erectile dusfunction

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15
Q

How does inadequate body fat affect women’s hormones

A

Decreases esteogen, LH, FSH

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16
Q

What did the Dutch famine reveal

A

Long terms affect of nutrient deficiencies were related to timing of insult

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17
Q

Children of pregnant women exposed to famine were more susceptible to

A

Obesity, diabetes, CVD, protein in urine and other health problems

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18
Q

Could the children of women exposed to famine who were small also make their children small

A

Yes

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19
Q

What is the barker hypothesis

A

Fetal under nutrition in middle to late gestation, which leads to disproportionate fetal growth, programs later CHD also lower glucose tolerance

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20
Q

What is vonsidered low birth weight

A

2.5kg

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21
Q

What is maternal fetal competition

A

Young mothers are more likely to have LBW babies due to the fetal-maternal competition as they are still growing themselves so they are fighting each other for the nutrients

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22
Q

What 7 micronutrients should mothers be keeping an eye on during periconception

A

Choline
Iron
Iodine
Zinc
Omega-3 fatty acids and B12
Multivitamins
Folic acid

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23
Q

What effect does iron have on periconception

A

Iron deficiency anaemia is linked with LBW, delayed development, preteen birth, infections and postpartum haemorrhage

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24
Q

What effect does iodine have on periconception

A

Neurocognitive

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25
Q

What effect does zinc have on periconception

A

Preterm birth
Placental function

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26
Q

Why have omega 3 fatty acids and b12 at periconception

A

Altered lipid metabolism

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27
Q

Why multivitamins at periconception

A

Neural tube defects, congenital heart defect
Urinary tract defect
Limb reduction defect
Preeclampsia

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28
Q

What have folic acid at periconception

A

Neural tube defects
Congenital malformations
Preeclampsia
Autism spectrum disorder
Increase sperm count and viability

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29
Q

Why have choline at periconception.

A

Brain development

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30
Q

When should you take folic acid periconception

A

800mcg tablet daily 4weeks before and 12weeks after becoming. Pregnant

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31
Q

How is mandatory folate fortification of bread expected to reduce NTD

A

Reduce annually between 4-14

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32
Q

Why does WHO Recommend having vit A for pregnant women

A

Prevent night blindness in deficient settings

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33
Q

How are population and fertility rates changing

A

Fertility rates are decreasing but population increasing

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34
Q

How many stages of pregnancy are there

A

10

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35
Q

What is the first stage of pregnancy

A

Conception - sperm fertilises the egg - embryo attaches to uterine wall

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36
Q

What is the second stage of pregnancy

A

4 weeks - structures that form the neck and face begin to become evident. Organs start (lungs, stomach and liver) or continue (heart, blood vessels) to develop. Home preg test are now positive

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37
Q

What is the first organ to develop in babies

A

brain

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38
Q

3rd stage of pregnancy

A

8 weeks - babies now the size of a grape. Face structures are forming. Arms and legs are now formed and fingers and toes more distinct. Embryo now considered a fetus

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39
Q

4th stage of pregnancy

A
  1. 12 weeks - fetus starts to make its own movements; Baby has detectable heartbeat and sex organs of baby should start to become clear.
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40
Q

5 th stage of pregnancy

A
  1. 16 weeks - baby can now blink and the heart and blood vessels are now fully formed; fingers and toes should have prints
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41
Q

6th stage of pregnancy

A
  1. 20weeks - baby can suck thumb, yawn, stretch and make faces. Mother should now feel the baby moving.
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42
Q

7th stage of pregnancy

A

24 weeks - baby responds to sounds by moving or increasing pulse; inner ear is devloped so may be able to sense being upside down.

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43
Q

8th stage of pregnancy

A
  1. 28weeks - baby changes position frequently; theres a good chance of survival if baby was born premature now
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44
Q

9th stage of pregnancy

A
  1. 32weeks - layer of fat starts to form underskin making it become less wrinkly; it will gain up to half its birth weight between now and pregnancy
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45
Q

10th stage of pregnancy

A
  1. 36weeks - the brain is developing rapidly now; lungs are nearly fully developed; head is usually positioned down into the pelvis now
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46
Q

amniotic sac

A
  • Membrane that forms around the embryo 2 weeks after conception, filled mainly with water
    -way to feed the baby with PRO, CHO, lipids, phospholipids, urea and electrolytes.
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47
Q

What does the fluid in the amniotic sac allow the fetus to do

A

move and protects it from infection, temperature, dehydration and impact.

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48
Q

what are teratogens

A

Any agent that can disturb the development of an embryo or fetus. May cause a birth defect or halt the pregnancy.

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49
Q

What are the 4 classes of teratogens

A

radiation, maternal infections, chemicals and drugs.
- Once the kids are further developed they become less sensitive to the teratogens

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50
Q

pre natal period

A

From conception until birth

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51
Q

postnatal period

A

from birth till death

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52
Q

What is EDD

A

estimated date of delivery

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53
Q

1st trimester

A

conception till 12th week

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54
Q

2nd trimester

A

13th to 28th weeks

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55
Q

3rd trimester

A

29th to birth

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56
Q

pre term

A

<37weeks

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57
Q

post term

A

> 42weeks

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58
Q

when do ultrasounds normally occur

A

8 weeks - confirming pregnancy and estimating birth date
12-14 weeks - can screen for down syndrome etc. - based on a risk assessment
18-20 weeks - anatomy scan

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59
Q

pre term birth complications

A

short term:
respiratory distress syndrome
Heart: patent ductas arteriosus
brain: intraventricular hemorrhage
GI: necrotizing enterocolitis
Long term:
cognitive, vision, hearing, ADHD, anxiety, asthma, SIDS

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60
Q

what does the placenta do?

A

carries oxygen, nutrients and antibodies from mother to fetus and waste material including CO2 from fetus to mother

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61
Q

how is the placenta connected to the embryo/ fetus

A

umbilical cord

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62
Q

What hormones does the placenta produce

A

Human chorionic gonatropin (HCG)
progesterone
relaxin
human placental lactogens

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63
Q

What does HCG hormone do

A

prevents ovaries from releasing eggs and stimulates the ovaries to produce estrogen and progesterone

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64
Q

What does progeterone released from placenta do

A

produced by placenta after 12weeks. Is primarily responsible for maintenance of pregnancy.

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65
Q

What does relaxin produced by placenta do

A

acts with progesterone to maintain pregnancy and relaxation of pelvic ligaments towards end

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66
Q

What does human placental lactogens produced by placenta do

A

(prolactin and growth hormone) to promote mammory gland (boobs) growth

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67
Q

what are the placenta transport mechanisms

A

passive diffusion
facilitated diffusion
active transport
solvent drag

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68
Q

how much weight is gained during pregnancies

A

12-15kg

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69
Q

What causes weight gain during pregnancy

A

fat disposition, growth of reproductive organs, fetal tissues

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70
Q

what stops the menstural cycle during pregnancy

A

progesterone and oestrogen - they rise continually throughout pregnancy

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71
Q

what does high levels of oestrogen during pregnancy do

A

promotes prolactin

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72
Q

what does prolactin during pregnancy do

A

mediates a change in the structure of mammary glands from ductal to lobular-alveolar = milk hormone

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73
Q

why is parathyroid hormone increased during pregnancy

A

to enhance calcium uptake in the gut and reabsorption in the kidney

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74
Q

which adrenal hormones increase during pregnancy

A

cortisol and aldostreone

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75
Q

Where is human placental lactogen (HPL) produced from

A

placenta

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76
Q

what does HPL DECREASE during pregnancy

A

maternal insulin sensitivity and maternal glucose utilization - this increases blood glucose levels and ensures ftus gets adequate nutrition

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77
Q

what does HPL increase during pregnancy

A

gluconeogenesis - to increase maternal blood glucose levels

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78
Q

what is HPL main purpose

A

to increase maternal blood sugar levels. this helps support fetal nutrition even when there maternal malnutrition

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79
Q

what are the renal changes during pregnancy

A

renal plasma flow increases

80
Q

what dies aldosterone do during pregnancy

A

increases the reabsorption of Na ions and secretion of K in the kidneys

81
Q

What dies EPO do during pregnancy

A

its a glycoprotein hormone that control RBC production

82
Q

what is the cardiovascular change during pregnancy

A

cardiac output increases from 30-50%

83
Q

When does the cardiac output changes occur

A

by week 6 and peaks between 16 and 28

84
Q

Why does increased cardiac output occur

A

demands of uteroplacental circulation

85
Q

how does the cardiac output increase

A

HR increase from 70-90 bpm
stroke volume increases

86
Q

why does BP usually drop even though cardiac output has increased

A

because of expanding space in the uterus and developmant of the placenta and systemic vascular resistance decreases

87
Q

why does lung function change during pregnancy

A

partly due to progesterone increases and partly due to enlarging unterus interferes with lung expansion

88
Q

what are the hematological changes

A

blood volume increases
plasma vloume increases

89
Q

If plasma volume increases will haemoglobin be lower or higher

A

lower - additional anaemia

90
Q

what are gastrointestinal changes during pregnancy

A

constpation - due to enlarging reproductive organs
GI motility decreases because of progesterone relaxing smooth muscles
heart burn and belching
HCl production decreases

91
Q

What should you do diet wise to prevent NVP (morning sickness) from being so bad

A

eat what appeals
eat slowly and small amounts
frequent small CHO meals
ginger and B6 supplements
pharmacological treatments

92
Q

is ginger or B6 better at removing NVP symptoms

A

ginger - but not significantly differnt

93
Q

what is a safe dose of ginger

A

1g/day, 3-4x

94
Q

How much does the BMR increase during pregnancy

A

450-750kj/d

95
Q

What causes the BMR to increase during pregnancy

A

added metabolism of uterus and fetus and incresed work of heart and lungs

96
Q

How much does the TEE (total enenrgy expenditure) increase suring pregnancy

A

450-750kj/d

97
Q

Apart from TEE what is the other factor that increases maternal energy requirements

A

deposition of maternal and fetal tissue

98
Q

how much increase of energy is required in the 1st trimester

A

none

99
Q

hoe much increase of energy is required in the 2nd trimester

A

1400kj/d

100
Q

how much increased energy is required during 3rd trimester

A

1900kj/d

101
Q

where is the majority of weight gain from in mothers

A

the fetus

102
Q

apart from fetus weight what is the other major contributor of weight gain

A

maternal fat stores

103
Q

how should overweight/obese people weight gain during pregnancy differ to nirmal or underweight

A

they should gain less as they already have some of the fat stores required etc.

104
Q

when does most of the weight gain occur during pregnancy

A

2nd and 3rd trimester

105
Q

how much weight should underweight mothers gain during pregnancy

A

0.51 kg/week
or just gain as much weight as they can

106
Q

how much weight should normal weight mothers gain during pregnancy

A

0.42 kg/week
or 17-25kg overall

107
Q

how much weight should overweight mothers gain during pregnancy

A

0.28 kg/week
or 14-23kg overall

108
Q

how much weight should obese mothers gain during pregnancy

A

0.22kg/week
or 11-19kg overall

109
Q

if youre having twins how much extra weight should you gain compared to single baby mothers

A

depends on prepregnancy weight but around 6-10kg

110
Q

when does gestational weight gain mostly occur

A

1/3 in 2nd trimester and
2/3 in 3rd trimester

111
Q

what are 2 pieces of advice for pregnant women to do with weight gain during pregnancy

A

height and weight measured at booking
women made aware of weight gain guidelines

112
Q

how can we prevent excessive gestational weight gain

A

diet, exercise or both

113
Q

What is the effect of postpartum weight retention

A

every pregnancy gain more weight so end up obese. so need to try come back to a healthy weight after each pregnancy

114
Q

Do we recommend weight loss during pregnancy

A

no just appropriate weight gain

115
Q

what % of women are entering pregnancy as overweigth or obese

A

54%

116
Q

How is obesity associated with miscarriage and stillbirths

A

increased risk

117
Q

How is obesity associated with pregnancy-induced hypertension

A

HIgh BP after 20wks gestation

118
Q

How is obesity associated with venous thromboembolism

A

increased risk - blood clot within vein

119
Q

How is obesity associated with delivery complications

A

increased risk - labour induction adn caesarean delivery

120
Q

How is obesity associated with diabetes

A

increased risk of gestational diabetes mellitus

121
Q

what is gestational diabtes

A

women without previously diagnosed diabetes exhibit high blood glucose levels durong pregnancy

122
Q

what effect does gestetional diabetes have on the baby

A

exposes baby to higher glucose levels
this leads to increase fetal levels of insulin
due to the growth stimulating effects of insulin this can lead to excessive growth and macrosomia (fetal overgrowth)
And a higher risk of developing T2D later in life

123
Q

what effects does gestational diabetes have on the mother

A

higher risk of getting it in future pregnancies
increased risk of T2D
c section more likely due to baby being bigger
induction if baby to big

124
Q

How do we detect gestational diabetes

A

screening recommened/offered by healthcarers

125
Q

What effects does maternal obesity have on the baby

A

increased risk of congenital abnormalities, NTD, small for gestational age, large for gestational age, neonatal mortality

126
Q

What are the key nutrients during pregnancy

A

LCPUFA
iron
iodine
calcium
vit A

127
Q

What do LCPUFA do for maternal nutrition?

A

normal fetal development- particularly neural and visual function

128
Q

What is a rich supply of n-3 fatty acids during pregnancy associated with

A

reduced incidence of low birth weight

129
Q

What effects do large amounts of methylmecury have on the baby

A

damage the development of nervous system of the fetus and delay mental development

130
Q

why do we need increased iron during pregnancy

A

maternal blood cell expands so we have more blood, we have the fetus which needs its own blood, and need to account for blood loss for the mother during pregnancy

131
Q

what is the RDI ofr pregnant women for iron

A

27mg/d

132
Q

What risk does iron deficiency have on the baby

A

LBW, small for gestational age (SGA) preterm birth, decreased infant iron stores, impaired cognition and growth of child

133
Q

What risk does iron deficiency have on mother

A

increase the risk of cardiac failure or death from peripartum hemorrhage

134
Q

What is the reccommended iron supplementation

A

60mg/d for pregnant women living in places where malnutrition is prevalent

135
Q

Is preventative iron supplementation beneficial

A

further investigation needed regarding risks and benefits

136
Q

What are some interventions aimed at preventing iron deficiency

A

food-based stratergies
iron supplementation
fortification of staple foods with iron
delayed or optimal cord clamping

137
Q

What does delayed cord clamping do

A

improves iron status of baby

138
Q

What does iron do during pregnancy

A

essential for production of thyroid hormones - these regulate metabolism and for normal growth and neurocognitve development of the fetus, infant and child

139
Q

What does severe iodine deficiency do

A

causes intellectual disability

140
Q

What is the recommendation for [reventing iodine deficiency

A

salt iodisation

141
Q

do pregnant women have a higher requirement for iodine deficiency

A

yes - meaning they’re more susceptible to iodine deficiency

142
Q

What is the recommendation for iodine supplementation for pregnant women

A

150mcg tablet once a day when pregnant and breastfeeding

143
Q

Why is calcium important in pregnancy

A

approx 30g calcium tranferred to fetal skeleton by end of pregnancy

144
Q

How do mothers get more calcium during pregnancy

A

increased intestinal absorption,

145
Q

Vit A requirement

A

important in reactions involving cell differentiation

146
Q

where does vit A deficinecy normally occur

A

rare in industrialised countries but major problem in developing

147
Q

What can a vit A deficiency do

A

malformation in fetal lungs, urinary tract and heart

148
Q

What can excessive intakes of vit A do?

A

increase risk of fetal abnormalities

149
Q

What is listeria

A

risk of listeriosis - food bourne bacteria - doesnt cause problems in helathy individuals but problem in immune compromised

150
Q

What are listeria symptoms

A

influenza type symptoms and can result in premature labour and reduced fetal movements

151
Q

What precautions should you take to prevent lysteria

A

foods should be heated to 70c+
pregnant women should avoid unsafe foods

152
Q

2 unsafe foods for lysteria

A

uncooked, smoked or ready to eat fisj or seafood.
pre prepared or stored salads and coleslaws

153
Q

What is toxoplasmosis

A

is a parasitic disease

154
Q

What can toxoplasmosis do

A

cause eye or brain damage in unborn babies

155
Q

Where can toxoplasmosis infection come from

A

similar to listeria + cats

156
Q

how does alcohol physiologically affect baby

A

readily crosses the placenta so baby levels are similar to maternal

157
Q

What is the main effect of drinking alcohol whilst pregnant

A

fetal alcohol syndrome

158
Q

What is fetal alcohol syndrome

A

growth deficinecy
CNS disfunction
specific pattern of facial charateristics

159
Q

What are NZ recommendation for mothers to do with alcohol

A

avoid drinking for entire pregnancy

160
Q

What are the 2 lactation hormones

A

prolactin and oxytocin

161
Q

What does prolactin do for lactation

A

stimulates milk production via suckling,

162
Q

what suppresses prolactin

A

prolactin-inhibitin factor - released during last 3 months of pregnancy to allow body to prepare for milk production

163
Q

What does oxytocin do for lactation

A

stimulates ejection of milk from the milk gland into duct via suckiling

164
Q

What is lactogenesis

A

milk production

165
Q

what is the 1st stage of lactogenesis

A

begins last trimester of pregnancy
1st stage of milk production extends to first few days postpartum

166
Q

Lactogenesis 2

A

begins 2-5 days postpartum
increased blood flow to mammary gland
when milk ‘comes in’
change in milk composition

167
Q

lactogenesis 3

A

marked by stable milk composition
maintenance stage

168
Q

When is colostrum produced

A

mid pregnancy to first few days after birth

169
Q

What is colostrum milk like

A

thick, sticky, concentrated milk with a mild laxative effect

170
Q

what is. the general composition of colostrum

A

lymphocytes
IgA, IgM - help with immunisation
high protein (low fat)
vitamins and minerals

171
Q

When should breastfeeding be initiated

A

within first hour after birth

172
Q

what are the babies signs to initiate feed

A

suck and swallow - coordianted pattern
oral search reflex
rooting reflex

173
Q

how does breastfeeding work

A

suction created by the babies mouth creates pressure and teat ejects milk

174
Q

Ways to establish breast feeding

A

skin to skin contact
staying hydrated
responsive feeding - babies hunger cues
emptying breasts

175
Q

What is breast milk made up of (10)

A

water
protein
CHO (lactose)
various fats
antibodies
vitamins and minerals
human milk oligosaccharides
800 strands bacteria
other immune cells
hormones

176
Q

What % of milk is water

A

88%

177
Q

do babies need water

A

no if they’re breastfed

178
Q

How does milk composition change in terms of fat

A

low fat at beginning higher towards end

179
Q

Protein in milk

A

relatively low amount

180
Q

CHO in milk

A

mostly lactose

181
Q

what is human milk oligosaccharides

A

complex, indigestable, medium length CHO with lactose on one end

182
Q

Whhat do prebiotics do in human milk

A

stimulate groeth of good bacteria. and inhibits bad bacteria

183
Q

What are group 1 vitamins and minerals

A

ones that are affected by maternal status

184
Q

What are group 2 vitamins

A

not affected by maternal status

185
Q

What is the features of iron in human milk

A

iron concentration is low but highly bioavailable

186
Q

what dies lactoferrin do

A

inhibits growth of some tumours and also halps babies absorb iron (founf in teh milk)

187
Q

What affect does sustained IDA have on babies

A

irreversable amd detrimental effects on intellectual and motor performance

188
Q

What are the estimated energy requirements of lactating women

A

0-6months 2000 kj above non pregnant non lactating women
>6months 1680kj

189
Q

What are the WHO recommendations to help breast feeding

A

start within 1st hour
exclusive breastfeeding - only breast milk nohing else
breastfeed baby on demand
no use of bottles, teats or pacifiers

190
Q

How long is exclusive breast feedong recommended for

A

first 6 months

191
Q

How long should babies be breast fed for

A

up to 2 years or longer

192
Q

what is partial breast feeding

A

baby receives some breast milk and some infant formula or other solid food

193
Q

What are benefits of breast feeding for baby

A

reductions in infant morbidity and mortality
reductions in chronic disease
increased cognitive function

194
Q

benefits of breastfeeding for mother

A

protects mothers health
helps delay new pregnancy
help mother return to prepregnancy weight

195
Q

definition of baby friendly hospital

A

a health car facility where the practitioners who care for women and babies adopt practices that aim to protect, promote and support exclusive breastfeeding from birth (while also ensuring those who choose not to are supported)

196
Q

what is the international code of marketing of breast milk substitutes

A

restrict the marketing of breast milk substitutes to ensure that mothers are not discouraged from breatfeeding and that substitutes are used safely if needed

197
Q
A

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